as a cell block. The larger fragments that can be easily handled with forceps can be placed directly into a cassette in a manner similar to grossing core biopsies or combined in the cell block. In cases where two blocks are created, one using centrifugation and the other without centrifugation, they are still best handled by the same (cytology) laboratory and assigned the same laboratory accessioning number to avoid discrepant reporting and redundant ancillary testing. Unfortunately, there is no standardized protocol to manage these newer specimens. With suboptimal management of such specimens and lack of communication concerning the added value of capturing more cells within a cell block, cytology risks losing these specimens to surgical pathology, which may result in loss of the important background cellular component of the sample, inferior quality of the final product, and thus substandard quality of the final diagnosis and patient care.
Conclusion
A plethora of old and new methods are available for routinely preparing cell blocks in cytology practice. However, to date no single method has been widely adopted by all cytology laboratories. Several steps can be undertaken to enhance the cellularity of cell blocks, some which occur at the point-of-care, including better operator skill, enhanced specimen adequacy, proper triage, and dedicated passes for cell block [19], and others which can be implemented in cytology and histology laboratories. Despite ongoing development of new and improved cell block techniques, the production and optimal utilization of cell blocks remains a work in progress that requires standardization. This is important because without assured adequate cellularity in cell blocks, the tendency will be to continually move towards competing specimens such as core-needle biopsies or hybrid cytology-histology samples.
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